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So I've posted on the Anesthesiology forum. Exclusively. Until now.
Here's a hypothetical case I want to see how you guys would handle...
47 y.o. male comes to ED with 3-4 day history of progressive diarrhea. Worse over the last 24 hours. No fever. But hypotension, tachycardia. Hyperactive bowel sounds, but no peritoneal signs. Appy is still present (i.e. no prior abdominal surgery). WBC's are 21k. Lightheadeness, non-vertiginous. No chest pain, no shortness of breath. Reports he has continued his home meds. No recent antibiotics. No recent travel. No recent sick contacts he's aware of.
Relevant history: chronic HTN, intermittent EtOH abuse/recovering alcoholic (none recently per patient), anxiety/depression, T&A as a child, knee scope in the past
Home meds: Celexa, Trazadone, Librium, lisinopril, Ativan PRN
Social: prior heavy ethanol intake (none in past 6 months, per patient), non-smoker, no illicit substances, works as an attorney, married and lives with wife, no children
PE: BP 68/40, P-116, T=37.2, R-20, SpO2 = 98% on 2L
Gen: awake, conversant, non-diaphoretic, not clearly in distress
Chest: clear, no wheezes
Card: tachy, regular
Abd: NT/ND, thin
Extr: thin, poor skin turgor, pulses thready
Neuro: CN 2-12 WNL, non-focal
Rest of exam is WNL
Tests already done: BUN = 57, Creat = 2.7, K+ = 3.1, Na+ = 136, WBC = 21k, 11% bands; Hb/Hct = 14.1/42%, heme (-) stool, CT scan negative for acute intrabdominal process, C. diff toxin (-), EKG sinus tach, no ST-T wave changes, 1st troponin negative, stool O&P sent (pending)
How would you manage this patient? Would you push to admit them?
Here's a hypothetical case I want to see how you guys would handle...
47 y.o. male comes to ED with 3-4 day history of progressive diarrhea. Worse over the last 24 hours. No fever. But hypotension, tachycardia. Hyperactive bowel sounds, but no peritoneal signs. Appy is still present (i.e. no prior abdominal surgery). WBC's are 21k. Lightheadeness, non-vertiginous. No chest pain, no shortness of breath. Reports he has continued his home meds. No recent antibiotics. No recent travel. No recent sick contacts he's aware of.
Relevant history: chronic HTN, intermittent EtOH abuse/recovering alcoholic (none recently per patient), anxiety/depression, T&A as a child, knee scope in the past
Home meds: Celexa, Trazadone, Librium, lisinopril, Ativan PRN
Social: prior heavy ethanol intake (none in past 6 months, per patient), non-smoker, no illicit substances, works as an attorney, married and lives with wife, no children
PE: BP 68/40, P-116, T=37.2, R-20, SpO2 = 98% on 2L
Gen: awake, conversant, non-diaphoretic, not clearly in distress
Chest: clear, no wheezes
Card: tachy, regular
Abd: NT/ND, thin
Extr: thin, poor skin turgor, pulses thready
Neuro: CN 2-12 WNL, non-focal
Rest of exam is WNL
Tests already done: BUN = 57, Creat = 2.7, K+ = 3.1, Na+ = 136, WBC = 21k, 11% bands; Hb/Hct = 14.1/42%, heme (-) stool, CT scan negative for acute intrabdominal process, C. diff toxin (-), EKG sinus tach, no ST-T wave changes, 1st troponin negative, stool O&P sent (pending)
How would you manage this patient? Would you push to admit them?
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